PoV examines key steps payers must take to establish and successfully manage ACOs - enhancing their ability to remain competitive through 2012 and beyond
Introduction & EHR Benefits RealizationDave Shiple
Divurgent is a healthcare consulting firm that helps clients realize benefits from their EHR investments. They have experts who previously served as CIOs and provide services around IT strategy, meaningful use, benefits realization, and clinical integration. Hard dollar ROI from EHRs is possible but requires planning and accountability. Benefits realization exercises should focus on a few high-value metrics that are easy to measure, such as reductions in wait times, costs, and staff. Ensuring process owners are engaged from the start and accountable for benefits is key to success.
Grants Management in the Era of Accountability: Performance Measures in the Uniform Guidance Shane Jernigan Senior Instructional Designer, Grants & Assistance Division Management Concepts Executive Summary Successful management of Federal grants has always required skill, practice, patience, and even a little luck. As policymakers and the public have grown increasingly concerned about “wasteful government spending,” grants managers have had to adapt to new regulations and additional oversight. In this “Era of Accountability,” Federal awarding agencies and non- Federal recipient entities must remain vigilant in protecting Federal funds from waste, fraud, and abuse.
The document discusses the development of High Performance Clinically Integrated Organizations (HPCIOs). It provides Advocate Physician Partners in Chicago as an example of a clinically integrated network of 3,800 physicians and 10 hospitals that has achieved $60 million in pay-for-performance bonuses. The document also discusses how HPCIO criteria are being aligned with CMS rules for Accountable Care Organizations (ACOs) in order to reduce antitrust risks and ensure organizations can participate in the Medicare Shared Savings Program.
Overlapping stages, tactical documents and prescriptive benefit characteristics to enhance the realization of strategic benefits.
Enterprise and program strategies feed in to the benefits lifecycle and the development of a Business Case. That Case utilizes the strategies to identify and quantify a ROM CBA and acknowledge any dis-benefits. Assign a Business Benefits Owner as early as possible to plan for the realization and eventual transition off the project.
In the transition, the Benefit Owner must manage and report on the benefit and conversations happen to understand the impact of the benefits realized or NOT realized. Are new opportunities created because of it? Are the aforementioned Strategies affected? Are we ready to decommission the investment?
Acknowledgement to Stephen Jenner and Carlos Serra - I've gained so much understanding from your published works.
This document outlines the key stages in a benefits management process including benefit identification, quantification, validation, ownership assignment, monitoring and controlling, and reporting. The process involves identifying potential benefits, mapping and quantifying them, socializing and assigning ownership, executing projects to realize benefits, and leveraging realized benefits in annual planning through ongoing monitoring, controlling and reporting.
The document describes two case studies involving priority setting in Ontario health systems. The first case study describes how 14 Local Health Integration Networks (LHINs) in Ontario developed a priority setting framework to guide resource allocation decisions. The second case study describes how Menno Place, a residential complex care facility, implemented priority-based management approaches to address a projected budget deficit of nearly $1 million.
GCG Financial is a benefits consulting firm that works with companies to design and implement employee benefits packages. They meet with ABC Company to discuss forming a benefits package that attracts and retains employees while controlling costs. GCG has expertise in benefits communication, plan design, benchmarking, and carrier relationships that allow them to create long-term sustainable benefits strategies. They have a strategic partnership with actuarial firm Milliman to provide data-driven insights and analysis.
Corporate Data Quality: Research and Services OverviewBoris Otto
The document provides an overview of corporate data quality research and services from the Competence Center Corporate Data Quality (CC CDQ) at the University of St. Gallen. It discusses how data quality is a success factor for business and introduces the CC CDQ's research focus areas, consortium of partner companies, and services which include assessments, strategy development, and knowledge sharing. The CC CDQ team leverages expertise in research and consulting to help organizations improve data quality management.
Introduction & EHR Benefits RealizationDave Shiple
Divurgent is a healthcare consulting firm that helps clients realize benefits from their EHR investments. They have experts who previously served as CIOs and provide services around IT strategy, meaningful use, benefits realization, and clinical integration. Hard dollar ROI from EHRs is possible but requires planning and accountability. Benefits realization exercises should focus on a few high-value metrics that are easy to measure, such as reductions in wait times, costs, and staff. Ensuring process owners are engaged from the start and accountable for benefits is key to success.
Grants Management in the Era of Accountability: Performance Measures in the Uniform Guidance Shane Jernigan Senior Instructional Designer, Grants & Assistance Division Management Concepts Executive Summary Successful management of Federal grants has always required skill, practice, patience, and even a little luck. As policymakers and the public have grown increasingly concerned about “wasteful government spending,” grants managers have had to adapt to new regulations and additional oversight. In this “Era of Accountability,” Federal awarding agencies and non- Federal recipient entities must remain vigilant in protecting Federal funds from waste, fraud, and abuse.
The document discusses the development of High Performance Clinically Integrated Organizations (HPCIOs). It provides Advocate Physician Partners in Chicago as an example of a clinically integrated network of 3,800 physicians and 10 hospitals that has achieved $60 million in pay-for-performance bonuses. The document also discusses how HPCIO criteria are being aligned with CMS rules for Accountable Care Organizations (ACOs) in order to reduce antitrust risks and ensure organizations can participate in the Medicare Shared Savings Program.
Overlapping stages, tactical documents and prescriptive benefit characteristics to enhance the realization of strategic benefits.
Enterprise and program strategies feed in to the benefits lifecycle and the development of a Business Case. That Case utilizes the strategies to identify and quantify a ROM CBA and acknowledge any dis-benefits. Assign a Business Benefits Owner as early as possible to plan for the realization and eventual transition off the project.
In the transition, the Benefit Owner must manage and report on the benefit and conversations happen to understand the impact of the benefits realized or NOT realized. Are new opportunities created because of it? Are the aforementioned Strategies affected? Are we ready to decommission the investment?
Acknowledgement to Stephen Jenner and Carlos Serra - I've gained so much understanding from your published works.
This document outlines the key stages in a benefits management process including benefit identification, quantification, validation, ownership assignment, monitoring and controlling, and reporting. The process involves identifying potential benefits, mapping and quantifying them, socializing and assigning ownership, executing projects to realize benefits, and leveraging realized benefits in annual planning through ongoing monitoring, controlling and reporting.
The document describes two case studies involving priority setting in Ontario health systems. The first case study describes how 14 Local Health Integration Networks (LHINs) in Ontario developed a priority setting framework to guide resource allocation decisions. The second case study describes how Menno Place, a residential complex care facility, implemented priority-based management approaches to address a projected budget deficit of nearly $1 million.
GCG Financial is a benefits consulting firm that works with companies to design and implement employee benefits packages. They meet with ABC Company to discuss forming a benefits package that attracts and retains employees while controlling costs. GCG has expertise in benefits communication, plan design, benchmarking, and carrier relationships that allow them to create long-term sustainable benefits strategies. They have a strategic partnership with actuarial firm Milliman to provide data-driven insights and analysis.
Corporate Data Quality: Research and Services OverviewBoris Otto
The document provides an overview of corporate data quality research and services from the Competence Center Corporate Data Quality (CC CDQ) at the University of St. Gallen. It discusses how data quality is a success factor for business and introduces the CC CDQ's research focus areas, consortium of partner companies, and services which include assessments, strategy development, and knowledge sharing. The CC CDQ team leverages expertise in research and consulting to help organizations improve data quality management.
This document outlines 10 steps that corrections directors can take to strengthen performance in their agencies. These steps include reevaluating the agency mission to include reducing recidivism, developing meaningful performance measures, making better use of technology, focusing on infrastructure needs, seeking alternative funding, improving medical cost partnerships, rethinking financial strategies, holding managers accountable, prioritizing security staff compensation, and developing new leadership programs. The strategies are aimed at improving operations, accountability, and cutting costs in corrections systems.
The document discusses performance management systems and how they can help health care organizations navigate challenges. Specifically, it discusses:
1) How Kurt Salmon Associates provides management consulting services including strategy, facility planning, and IT to various health care providers.
2) How performance management systems like the Balanced Scorecard can help organizations link strategic objectives to operations by monitoring key performance indicators.
3) An example of how a performance scorecard could be designed for a cardiology center of excellence, identifying objectives, metrics, and the relationships between metrics in each of the four Balanced Scorecard perspectives: financial, internal processes, learning and growth, and customers.
Result based financng for health - Health Results Innovation Trust FundRikuE
The World Bank aims to improve health results in developing countries through a Results-Based Financing approach. A Health Results Innovation Trust Fund will provide grants and technical support to pilot RBF programs in select countries. These pilots will test how incentivizing health providers and consumers to achieve health targets can strengthen health systems and outcomes related to maternal and child health. The Fund will also support rigorous evaluations of the pilots and disseminate lessons learned to inform the design of RBF programs globally.
Aya Powerpoint Corporate Presentation 2012 2013Joshua Jeffries
This document provides an overview of the services offered by Arkin Youngentob Associates, LLC to support clients with comprehensive employee benefit solutions. They take a strategic, independent advisor approach to benefits consulting across four levels of a corporate lifecycle. Their services include benefits planning, vendor management, compliance support, communication tools, and proprietary technology platforms to help clients navigate healthcare reform.
The document discusses planning benefits realization from investments in information systems and technology. The main activities in benefits planning include finalizing benefit measurements and changes, obtaining stakeholder agreement on responsibilities, and producing a benefits plan and investment case. Key questions focus on how benefits will be defined, tracked, and reviewed. Executing the plan involves monitoring and evaluating results to identify both achieved and unexpected benefits, as well as any outstanding benefits or reasons why benefits were not achieved.
Benefits realization management - how to do it right - Wovex and Trevor Howes...Wovex Limited
Benefits realization management is important and hard to do it right.
Understand more about areas of importance and expand your ability to be more successful with benefits realization management.
Wovex is software for Value and Benefit Realization Management at https://www.wovex.com/
EFQM Excellence Model for Corporate Data Quality Management (CDQM)Boris Otto
This presentation gives an overview of the EFQM Execellence Model for Corporate Data Quality. The model supports the assessment of the maturity of enterprise-wide data quality management capabilities in multinational corporations. It was developed by the Competence Center Corporate Data Quality, a consortium research project at the University of St. Gallen, Switzerland.
The presentation was given at the Business Academic Exchange workshop at the 17th Americas Conference on Information Systems (AMCIS 2011) in Detroit, MI.
This document proposes a common outcome framework to help nonprofits more efficiently measure performance. It describes developing 14 program area profiles with outcomes, indicators, and sequence charts. These informed a draft common framework with core outcomes across program areas. Further testing and expansion is needed to refine and apply the framework more broadly. The goal is a standardized yet flexible approach to help nonprofits and funders assess impact in a consistent yet relevant way.
The document summarizes a review of progress made in implementing commitments under the International Health Partnership (IHP+), including:
1) Partners have taken initial actions towards IHP+ goals but it is too early to assess long-term impacts. Coordination is increasing but cooperation and collaboration need more work.
2) Country compacts are being developed but need to balance specificity and inclusiveness. Financing expectations may not be met given challenges in increasing funding.
3) Institutional reforms are needed within partner organizations to change incentives and empower staff to work differently. Civil society engagement also needs strengthening.
This document provides a floor-by-floor listing of rooms in a multi-level home located on Bourne St. near Catherine St. The first floor contains a bedroom, bathroom, and two large rooms. The second floor has a kitchen, three bedrooms, and the basement includes another bedroom, kitchen, and an unspecified room.
Let's Talk About RDA: RDA Resources - NLA/NEMA 2011Emily Nimsakont
This document provides an extensive list of online resources for learning about Resource Description and Access (RDA), including reports from the RDA test, materials from the Library of Congress, webinars and presentations, the RDA Toolkit, FRBR resources, places for discussion, and print resources on RDA and related topics such as FRBR. It aims to be a one-stop-shop for librarians and catalogers to find information about implementing RDA and transitioning to the new cataloging standard.
The Accidental Cataloger: Tips and Tools to Help You Use the RulesEmily Nimsakont
This document provides an overview of cataloging rules, standards, and resources for catalogers. It discusses the differences between AACR2 and RDA as well as MARC and BIBFRAME. It then lists several free sources for MARC records, such as the Library of Congress Catalog and AMICUS. Tools for working with MARC data like MARC converters, authorities, and tag references are presented. Finally, call number resources and training opportunities for catalogers are highlighted.
Linked Data for Law Libraries: An IntroductionEmily Nimsakont
This document summarizes Emily Dust Nimsakont's presentation on linked data for law libraries. She began by defining linked data and its key aspects, such as using URIs to identify things and linking data from different sources to connect and query it. She explained the principles of linked data using RDF graphs and triples. Nimsakont discussed benefits of linked data for libraries, such as new ways of searching and applications using structured data. For law libraries specifically, linked data can help address challenges of heterogeneous and changing legal information. She provided examples of existing linked open data sources and encouraged libraries to publish data following linked data best practices.
The document summarizes the role of non-coding RNAs in DNA replication initiation. It discusses how the Tetrahymena 26T RNA interacts with the origin recognition complex (ORC) to recruit it specifically to the rDNA origin for replication initiation. It also describes how the Epstein-Barr virus encodes a G-rich RNA that recruits the human ORC complex through its interaction with EBNA1. Additionally, the document outlines the essential role of vertebrate Y RNAs in mammalian DNA replication, particularly in the initiation step of the process.
This document discusses Edifecs' Population Payment Strategic Solution (PPSS) which helps health plans transition to value-based reimbursement models. PPSS uses population payment products and domain expertise to identify target populations, design programs, administer pilots, and monitor programs. It addresses challenges like performing data analysis, identifying quality metrics, modeling spending scenarios, and monitoring incentives. The solution analyzes claims, clinical and financial data to assist with accountable care programs from the pilot stage to ongoing administration.
Top 5 Things To Learn About CMS ACO Reach.pptxPersivia Inc
In today's ever-evolving healthcare landscape, the Centers for Medicare & Medicaid Services (CMS) constantly introduce new programs and models to improve the quality and efficiency of healthcare delivery. One such initiative is the CMS ACO Reach Platform.
Accountable Care Organizations: Savings, Quality, and Information TechnologyRobert Bond
The document discusses Accountable Care Organizations (ACOs) and how they can promote savings, quality, and the use of health information technology. It explains that ACOs bring local providers together to manage the total cost and quality of care for populations of patients. ACOs use a shared savings model where providers receive reimbursement from insurers based on meeting quality targets and reducing spending growth. The document outlines various levers ACOs can use related to demand, risk, cost, quality, and infrastructure to influence outcomes. It also provides examples of ACOs that have formed across the United States.
Five Macro Trends Driving Healthcare Industry Investment in 2011 and BeyondCognizant
Here are five industry trends that will strongly influence where and how healthcare ecosystem participants will invest business development and technology dollars this year and into 2012.
The document discusses Bergerac Systems considering backward integration by acquiring one of its major suppliers, GenieTech, to reduce production costs and fluctuations. Backward integration involves a company gaining control over its suppliers. Bergerac could buy GenieTech, which supplies plastic molding machines, for $5.75 million to fulfill its plastic needs and gain other benefits like overhead cost reductions. A second option discusses continuing relying on multiple suppliers but implementing supply chain improvements.
InfosysPublicServices - Accountable Care Organization Solution | ACO RegulationsInfosys
Accountable Care Organization Solution for payors Combines Comprehensive platform by providing Operational & Analytical Services. White Paper highlights Functional Landscape & key Features of the Platform.
This document outlines 10 steps that corrections directors can take to strengthen performance in their agencies. These steps include reevaluating the agency mission to include reducing recidivism, developing meaningful performance measures, making better use of technology, focusing on infrastructure needs, seeking alternative funding, improving medical cost partnerships, rethinking financial strategies, holding managers accountable, prioritizing security staff compensation, and developing new leadership programs. The strategies are aimed at improving operations, accountability, and cutting costs in corrections systems.
The document discusses performance management systems and how they can help health care organizations navigate challenges. Specifically, it discusses:
1) How Kurt Salmon Associates provides management consulting services including strategy, facility planning, and IT to various health care providers.
2) How performance management systems like the Balanced Scorecard can help organizations link strategic objectives to operations by monitoring key performance indicators.
3) An example of how a performance scorecard could be designed for a cardiology center of excellence, identifying objectives, metrics, and the relationships between metrics in each of the four Balanced Scorecard perspectives: financial, internal processes, learning and growth, and customers.
Result based financng for health - Health Results Innovation Trust FundRikuE
The World Bank aims to improve health results in developing countries through a Results-Based Financing approach. A Health Results Innovation Trust Fund will provide grants and technical support to pilot RBF programs in select countries. These pilots will test how incentivizing health providers and consumers to achieve health targets can strengthen health systems and outcomes related to maternal and child health. The Fund will also support rigorous evaluations of the pilots and disseminate lessons learned to inform the design of RBF programs globally.
Aya Powerpoint Corporate Presentation 2012 2013Joshua Jeffries
This document provides an overview of the services offered by Arkin Youngentob Associates, LLC to support clients with comprehensive employee benefit solutions. They take a strategic, independent advisor approach to benefits consulting across four levels of a corporate lifecycle. Their services include benefits planning, vendor management, compliance support, communication tools, and proprietary technology platforms to help clients navigate healthcare reform.
The document discusses planning benefits realization from investments in information systems and technology. The main activities in benefits planning include finalizing benefit measurements and changes, obtaining stakeholder agreement on responsibilities, and producing a benefits plan and investment case. Key questions focus on how benefits will be defined, tracked, and reviewed. Executing the plan involves monitoring and evaluating results to identify both achieved and unexpected benefits, as well as any outstanding benefits or reasons why benefits were not achieved.
Benefits realization management - how to do it right - Wovex and Trevor Howes...Wovex Limited
Benefits realization management is important and hard to do it right.
Understand more about areas of importance and expand your ability to be more successful with benefits realization management.
Wovex is software for Value and Benefit Realization Management at https://www.wovex.com/
EFQM Excellence Model for Corporate Data Quality Management (CDQM)Boris Otto
This presentation gives an overview of the EFQM Execellence Model for Corporate Data Quality. The model supports the assessment of the maturity of enterprise-wide data quality management capabilities in multinational corporations. It was developed by the Competence Center Corporate Data Quality, a consortium research project at the University of St. Gallen, Switzerland.
The presentation was given at the Business Academic Exchange workshop at the 17th Americas Conference on Information Systems (AMCIS 2011) in Detroit, MI.
This document proposes a common outcome framework to help nonprofits more efficiently measure performance. It describes developing 14 program area profiles with outcomes, indicators, and sequence charts. These informed a draft common framework with core outcomes across program areas. Further testing and expansion is needed to refine and apply the framework more broadly. The goal is a standardized yet flexible approach to help nonprofits and funders assess impact in a consistent yet relevant way.
The document summarizes a review of progress made in implementing commitments under the International Health Partnership (IHP+), including:
1) Partners have taken initial actions towards IHP+ goals but it is too early to assess long-term impacts. Coordination is increasing but cooperation and collaboration need more work.
2) Country compacts are being developed but need to balance specificity and inclusiveness. Financing expectations may not be met given challenges in increasing funding.
3) Institutional reforms are needed within partner organizations to change incentives and empower staff to work differently. Civil society engagement also needs strengthening.
This document provides a floor-by-floor listing of rooms in a multi-level home located on Bourne St. near Catherine St. The first floor contains a bedroom, bathroom, and two large rooms. The second floor has a kitchen, three bedrooms, and the basement includes another bedroom, kitchen, and an unspecified room.
Let's Talk About RDA: RDA Resources - NLA/NEMA 2011Emily Nimsakont
This document provides an extensive list of online resources for learning about Resource Description and Access (RDA), including reports from the RDA test, materials from the Library of Congress, webinars and presentations, the RDA Toolkit, FRBR resources, places for discussion, and print resources on RDA and related topics such as FRBR. It aims to be a one-stop-shop for librarians and catalogers to find information about implementing RDA and transitioning to the new cataloging standard.
The Accidental Cataloger: Tips and Tools to Help You Use the RulesEmily Nimsakont
This document provides an overview of cataloging rules, standards, and resources for catalogers. It discusses the differences between AACR2 and RDA as well as MARC and BIBFRAME. It then lists several free sources for MARC records, such as the Library of Congress Catalog and AMICUS. Tools for working with MARC data like MARC converters, authorities, and tag references are presented. Finally, call number resources and training opportunities for catalogers are highlighted.
Linked Data for Law Libraries: An IntroductionEmily Nimsakont
This document summarizes Emily Dust Nimsakont's presentation on linked data for law libraries. She began by defining linked data and its key aspects, such as using URIs to identify things and linking data from different sources to connect and query it. She explained the principles of linked data using RDF graphs and triples. Nimsakont discussed benefits of linked data for libraries, such as new ways of searching and applications using structured data. For law libraries specifically, linked data can help address challenges of heterogeneous and changing legal information. She provided examples of existing linked open data sources and encouraged libraries to publish data following linked data best practices.
The document summarizes the role of non-coding RNAs in DNA replication initiation. It discusses how the Tetrahymena 26T RNA interacts with the origin recognition complex (ORC) to recruit it specifically to the rDNA origin for replication initiation. It also describes how the Epstein-Barr virus encodes a G-rich RNA that recruits the human ORC complex through its interaction with EBNA1. Additionally, the document outlines the essential role of vertebrate Y RNAs in mammalian DNA replication, particularly in the initiation step of the process.
This document discusses Edifecs' Population Payment Strategic Solution (PPSS) which helps health plans transition to value-based reimbursement models. PPSS uses population payment products and domain expertise to identify target populations, design programs, administer pilots, and monitor programs. It addresses challenges like performing data analysis, identifying quality metrics, modeling spending scenarios, and monitoring incentives. The solution analyzes claims, clinical and financial data to assist with accountable care programs from the pilot stage to ongoing administration.
Top 5 Things To Learn About CMS ACO Reach.pptxPersivia Inc
In today's ever-evolving healthcare landscape, the Centers for Medicare & Medicaid Services (CMS) constantly introduce new programs and models to improve the quality and efficiency of healthcare delivery. One such initiative is the CMS ACO Reach Platform.
Accountable Care Organizations: Savings, Quality, and Information TechnologyRobert Bond
The document discusses Accountable Care Organizations (ACOs) and how they can promote savings, quality, and the use of health information technology. It explains that ACOs bring local providers together to manage the total cost and quality of care for populations of patients. ACOs use a shared savings model where providers receive reimbursement from insurers based on meeting quality targets and reducing spending growth. The document outlines various levers ACOs can use related to demand, risk, cost, quality, and infrastructure to influence outcomes. It also provides examples of ACOs that have formed across the United States.
Five Macro Trends Driving Healthcare Industry Investment in 2011 and BeyondCognizant
Here are five industry trends that will strongly influence where and how healthcare ecosystem participants will invest business development and technology dollars this year and into 2012.
The document discusses Bergerac Systems considering backward integration by acquiring one of its major suppliers, GenieTech, to reduce production costs and fluctuations. Backward integration involves a company gaining control over its suppliers. Bergerac could buy GenieTech, which supplies plastic molding machines, for $5.75 million to fulfill its plastic needs and gain other benefits like overhead cost reductions. A second option discusses continuing relying on multiple suppliers but implementing supply chain improvements.
InfosysPublicServices - Accountable Care Organization Solution | ACO RegulationsInfosys
Accountable Care Organization Solution for payors Combines Comprehensive platform by providing Operational & Analytical Services. White Paper highlights Functional Landscape & key Features of the Platform.
How to Build an Employee Benefits Package.pptxfarahat3
An employee benefits package is a set of perks and benefits offered to employees in addition to their salary. These benefits can include things like health insurance, retirement plans, paid time off, and professional development opportunities. Building an employee benefits package can help attract and retain top talent, as well as increase employee satisfaction and productivity. To build an employee benefits package, consider the needs and wants of your workforce, budget constraints, and industry standards. Then, choose benefits that align with your company's values and goals. Be sure to clearly communicate the details of the benefits package to your employees.
Developing End State Vision
Advice and Planning Strategy
Driving a Business Architecture
Provisioning a Portfolio of Projects
eGRC Operation Control
Minimizing Financial Risk
Aggregating Financial Risk
Managing Mainframe Entitlements
Implementing Data Governance
Understanding Data Lineage
Defining Global Customer Strategy
Complete Evaluation of CMS ACO Reach Program.pptxPersivia Inc
In the ever-evolving landscape of healthcare, the Centers for Medicare & Medicaid Services (CMS) continually seek innovative ways to improve the quality and efficiency of care delivery. One such initiative that has garnered significant attention is the CMS ACO Reach.
The document discusses how organizational value can be eroded throughout the project/program management lifecycle in three stages: value exaggeration, destruction, and decay. Value exaggeration can occur early in planning when benefits are optimistically estimated or stated without detailed understanding. Value destruction happens when delivery decisions are made based on cost/schedule alone without considering benefit impacts. Value decay results from failing to properly transition benefits realization after a program's completion. To prevent value erosion, the document recommends linking benefits to organizational value maps, systematizing benefits management processes, and improving collaboration between program, business, and finance teams.
Want to better understand what's driving value-based clinical and financial transformation? And, what you need to do to start planning for implementation?
The document provides a 5-step process for designing an employee benefits program: 1) Identify objectives and budget, 2) Conduct a needs assessment, 3) Formulate a benefits plan, 4) Communicate the plan to employees, and 5) Develop an evaluation process. Key aspects include determining objectives that align with business strategy, assessing employee needs through surveys, analyzing utilization of current plans, prioritizing benefits based on needs and budget, effective communication of the program, and periodic reviews to ensure objectives are met. The process aims to create a benefits program that attracts and retains employees while meeting cost constraints.
Many healthcare organizations seem to have been in perpetual pilot stage while experimenting with value-based payment models. Healthcare organizations are focusing their efforts in two primary areas: developing the skills to successfully manage at-risk contracts and, preparing for the considerable business and care delivery transformation necessary for true population health management. But what are the foundational competencies needed to take on risk? Healthcare organizations should consider the following 5 key areas: 1) at-risk contract management, 2) network management, 3) care management, 4) performance monitoring, and 5) improvement prioritization. The value of analytics in each of these competency areas is to prioritize limited resources on the highest impact area.
CFO Strategies for Balancing Fee-for-Service and ValuePhytel
Moving from fee-for-service to value-based care is not easy. However, leading health systems are all following a similar blueprint that enables the move to value-based care.
Download this whitepaper to learn how:
- Bon Secours Richmond - Closed 75,801 gaps in care within 12 months, generating $7 million in revenue for chronic & preventive care, while improving quality.
- Northeast Georgia Medical Center - Decreased HbA1C levels across uncontrolled diabetes by an average of 1.6 points within 120 days.
- Riverside Medical Center - Reduced unnecessary readmissions by 40% by using automation to reach and assess patients post discharge.
- Prevea Health - Increased care management productivity by 150% by automatically identifying high risk patients, and automating patient engagement.
The latest Retirement Plan News contains articles on the following: 1) Make Benchmarking Your Plan An Annual Exercise 2) Employer Contribution Trends 3) QDIAS Ten years On
This document discusses benefits management in the context of programmes and projects. It defines benefits management as a core activity that occurs throughout the lifecycle of a programme. The key aspects of benefits management discussed are identifying, profiling, planning, monitoring, and realizing benefits. Benefits are the drivers of a programme and their identification helps set targets and objectives. Both benefits and potential negative outcomes, called dis-benefits, need to be tracked. The approach to benefits management should continue throughout the full life cycle of a project or programme.
The document discusses best practices for assessing forecasting process performance. Traditionally, performance was assessed based on cost and accuracy, but a better approach integrates three dimensions: rolling forecasts that allow flexibility, consistency through bottom-up involvement of budget owners, and modeling focused on key drivers rather than excessive detail. Assessing the forecasting process helps organizations improve their capability to adapt to changing business conditions.
Gorman PwC Preparing for a DCAA Comp AuditRebecca Gorman
The Defense Contract Audit Agency (DCAA) has increased audits of government contractors' compensation costs. To prepare, contractors should develop a compensation strategy, assess market compensation, design a competitive program, submit it for approval, review administration processes, and prepare documentation. Contractors should establish market-based strategies approved by their boards, regularly benchmark jobs and pay against markets, and modify programs as needed. PwC can assist with all stages of preparation and response to audit findings.
Similar to Embracing Accountable Care - 10 Key Steps (20)
Demystifying Machine Learning for Manufacturing: Data Science for allInfosys
This document discusses using machine learning and analytics for manufacturing applications. It begins with an overview of industry 4.0 and the increasing connectivity in manufacturing through technologies like the industrial internet of things. It then discusses how machine learning techniques like classification, regression, clustering and dimensionality reduction can be applied to common use cases in manufacturing around areas like order to cash, core manufacturing, and procure to pay. Specific case studies are presented on using machine learning for energy optimization at Infosys campuses and predicting churn for a automotive manufacturer's connected vehicle subscription services. Visualization and condition-based monitoring using artificial intelligence are also discussed.
Infosys commissioned an independent market research company, Vanson Bourne, to investigate the use of digital technologies and key trends in nine industries. We surveyed 1,000 senior decision makers from business and IT, from large organizations with 1,000 employees or more and annual revenue of at least US$500 million.
The report aims to discover:
a) the surging tide of digital technology adoption in organizations – what is used and where?
b) the promised land of digital technology use, and the hurdles organizations face to get there
c) the biggest disruptive digital trends within the next three years and why organizations see them as vital to future success
The summary here presents the survey results and highlights the digital outlook that will define the healthcare industry strategy over the next three years.
5 tips to make your mainframe as fit as youInfosys
Just like a periodic health check-up is important to assess your overall well-being, a detailed reexamination of the enterprise IT landscape is paramount. We take a look at the various ways an enterprise needs to revamp its mainframe and sharpen its functionalities to stay ahead of the game. While APIs aid you in providing superior customer service, migrating to the cloud provides you with scalability and resilience. These and many more sub-offerings from Infosys aid your organization in staying agile and equipped to leverage the latest technologies to cater to the ever-changing market. Learn more.
This document discusses how Infosys helped modernize various clients' mainframe systems through automation, application redesign, and streamlining of processes. Some key outcomes included issuing cards faster and flagging fraud instantly for a financial institution, optimizing performance and helping launch new products and services worth $160 million for a British financial company, and improving auto-adjudication rates to 85% and saving $2 million for a healthcare giant. Overall, the case studies demonstrated benefits such as reduced costs, improved productivity, faster transactions and launches of new offerings through Infosys' fourth wave modernization services.
Human Amplification In The Enterprise - Resources and UtilitiesInfosys
Infosys commissioned a study to develop a research methodology and get insights into the current nature of digital transformation enterprises undergo, across industry verticals. This deck provides industry specific insights from Resources and Utilities.
The study sought to understand a) the specific drivers of digital transformation for enterprises, b) the various facets of this transformation, c) expected and ensuing outcomes, and d) the role of Artificial Intelligence (AI).
Human Amplification In The Enterprise - Telecom and CommunicationInfosys
Infosys commissioned a study to develop a research methodology and get insights into the current nature of digital transformation enterprises undergo, across industry verticals. This deck provides industry specific insights from Telecom and Communication.
The study sought to understand a) the specific drivers of digital transformation for enterprises, b) the various facets of this transformation, c) expected and ensuing outcomes, and d) the role of Artificial Intelligence (AI).
Human Amplification In The Enterprise - Retail and CPGInfosys
Infosys commissioned a study to develop a research methodology and get insights into the current nature of digital transformation enterprises undergo, across industry verticals. This deck provides industry specific insights from Retail and CPG.
The study sought to understand a) the specific drivers of digital transformation for enterprises, b) the various facets of this transformation, c) expected and ensuing outcomes, and d) the role of Artificial Intelligence (AI).
Human Amplification In The Enterprise - Manufacturing and High-techInfosys
Infosys commissioned a study to develop a research methodology and get insights into the current nature of digital transformation enterprises undergo, across industry verticals. This deck provides industry specific insights from Manufacturing and High-tech.
The study sought to understand a) the specific drivers of digital transformation for enterprises, b) the various facets of this transformation, c) expected and ensuing outcomes, and d) the role of Artificial Intelligence (AI).
Human amplification in the enterprise - Automation. Innovation. Learning.Infosys
Infosys commissioned a study to develop a research methodology and get insights into the current nature of digital transformation enterprises undergo, across industry verticals. This deck provides industry specific insights from Automation, Innovation and learning.
The study sought to understand a) the specific drivers of digital transformation for enterprises, b) the various facets of this transformation, c) expected and ensuing outcomes, and d) the role of Artificial Intelligence (AI).
Human Amplification In The Enterprise - Healthcare and Life SciencesInfosys
The document discusses the findings of a study on digital transformation and the role of artificial intelligence (AI) in enterprises. Some key findings include:
- 72% of healthcare and life sciences enterprises are undergoing full digital transformations while 23% are transforming partially
- Automating processes and enabling innovation are top priorities for digital transformation
- Adopting AI applications can help with automation, data processing, and decision making but challenges include lack of resources, skills, and understanding of AI's value
- Lifelong learning is seen as important for employees to gain new skills and remain relevant during transformations
Human Amplification In The Enterprise - Banking and InsuranceInfosys
The document summarizes key findings from a study on digital transformation and human amplification in the banking and insurance sectors. It finds that 76% of enterprises in these sectors are undergoing full digital transformations, with the goals of becoming more agile, customer-centric, and innovative. While progress has been significant for many, challenges remain around IT alignment, resources, and resistance to change. The study also examines how AI can support automation of processes and data-driven insights, as well as the need for lifelong learning to ensure employees can acquire new skills.
This document discusses how Infosys helped modernize various clients' mainframe systems through automation, application redesign, and streamlining of processes. This enabled clients across different industries like financial services, healthcare, retail, and insurance to launch new products and services faster, reduce costs, improve system performance, and better serve their customers through faster processing, reduced fraud, and improved user experience. Infosys helped clients save millions of dollars in costs while improving productivity, compliance, and business operations overall.
Reimagining the future of IT InfrastructureInfosys
This document discusses how Infosys helped various companies reinvent and modernize their IT infrastructure to simplify processes, increase efficiencies, reduce costs and risks, and keep pace with changing business and customer needs. Examples include helping retailers manage business systems easily, oil companies access data faster at lower costs, food companies optimize supply chains, and pharmaceutical companies accelerate drug discovery, testing and production.
This document summarizes the results of a survey of 1,600 IT and business decision makers from organizations with over 1,000 employees and at least $500M in annual revenue across seven countries. The survey looked at companies' current status and motivations for adopting artificial intelligence as well as their preparations for and barriers to AI use. Key findings include that 25% of companies have fully deployed at least one AI solution and expect a 39% revenue rise by 2020 from AI. Most companies are investing in supporting IT infrastructure and developing internal knowledge for AI planning. The majority see ethics as important but over half believe ethical concerns currently limit AI's effectiveness. Future skills needs include active learning, complex problem solving and critical thinking.
The document discusses the findings of a Forrester Consulting study commissioned by Infosys on digital transformation. The study found that only 9% of firms have achieved digital maturity, while 69% believe they lack a systematic digital strategy. Organizational issues like a lack of digital skills and competing agendas are key barriers. Having the CEO responsible for the digital vision is linked to higher levels of digital maturity and investment. To succeed, organizations must address both digital customer experience and operational excellence through restructuring, replatforming technology, and transforming culture.
InfosysDigital creates customer delight across industries for companies like Anglian Water, Avivia Health, Belgacom, Chobani LLC, Darden Restaurants, GSK, Hilti, ICICI Bank, Bank Muscat Oman, Talk Talk, Vodafone, and more. The document encourages the reader to dive deeper and learn more about each company's digital solutions and experiences. It directs the reader to contact InfosysDigital for additional information.
Digital payments are becoming the norm as customers increasingly rely on digital services and conduct transactions online rather than with physical cards or cash. Key trends include the growth of peer-to-peer and business-to-business digital payments, tokenization standards, smart point-of-sale devices, and passive contactless payments. Payment providers face both opportunities and threats from new digital technologies and entrants, and must transform their organizations, technologies, and business models to keep up with rapidly changing customer expectations and remain competitive in the digital landscape.
Take a glimpse at few of our efforts that we made to demonstrate that efficient technologies can easily be deployed in large scale in a cost effective manner to make our campus environmental friendly on this World Environment Day 2015
The Information Services industry is in the eye of the digital storm. Two major contenders within this industry - traditional and new age media companies must adopt strategies for the significant mass of millennials and demanding consumers.
13 Jun 24 ILC Retirement Income Summit - slides.pptxILC- UK
ILC's Retirement Income Summit was hosted by M&G and supported by Canada Life. The event brought together key policymakers, influencers and experts to help identify policy priorities for the next Government and ensure more of us have access to a decent income in retirement.
Contributors included:
Jo Blanden, Professor in Economics, University of Surrey
Clive Bolton, CEO, Life Insurance M&G Plc
Jim Boyd, CEO, Equity Release Council
Molly Broome, Economist, Resolution Foundation
Nida Broughton, Co-Director of Economic Policy, Behavioural Insights Team
Jonathan Cribb, Associate Director and Head of Retirement, Savings, and Ageing, Institute for Fiscal Studies
Joanna Elson CBE, Chief Executive Officer, Independent Age
Tom Evans, Managing Director of Retirement, Canada Life
Steve Groves, Chair, Key Retirement Group
Tish Hanifan, Founder and Joint Chair of the Society of Later life Advisers
Sue Lewis, ILC Trustee
Siobhan Lough, Senior Consultant, Hymans Robertson
Mick McAteer, Co-Director, The Financial Inclusion Centre
Stuart McDonald MBE, Head of Longevity and Democratic Insights, LCP
Anusha Mittal, Managing Director, Individual Life and Pensions, M&G Life
Shelley Morris, Senior Project Manager, Living Pension, Living Wage Foundation
Sarah O'Grady, Journalist
Will Sherlock, Head of External Relations, M&G Plc
Daniela Silcock, Head of Policy Research, Pensions Policy Institute
David Sinclair, Chief Executive, ILC
Jordi Skilbeck, Senior Policy Advisor, Pensions and Lifetime Savings Association
Rt Hon Sir Stephen Timms, former Chair, Work & Pensions Committee
Nigel Waterson, ILC Trustee
Jackie Wells, Strategy and Policy Consultant, ILC Strategic Advisory Board
Confirmation of Payee (CoP) is a vital security measure adopted by financial institutions and payment service providers. Its core purpose is to confirm that the recipient’s name matches the information provided by the sender during a banking transaction, ensuring that funds are transferred to the correct payment account.
Confirmation of Payee was built to tackle the increasing numbers of APP Fraud and in the landscape of UK banking, the spectre of APP fraud looms large. In 2022, over £1.2 billion was stolen by fraudsters through authorised and unauthorised fraud, equivalent to more than £2,300 every minute. This statistic emphasises the urgent need for robust security measures like CoP. While over £1.2 billion was stolen through fraud in 2022, there was an eight per cent reduction compared to 2021 which highlights the positive outcomes obtained from the implementation of Confirmation of Payee. The number of fraud cases across the UK also decreased by four per cent to nearly three million cases during the same period; latest statistics from UK Finance.
In essence, Confirmation of Payee plays a pivotal role in digital banking, guaranteeing the flawless execution of banking transactions. It stands as a guardian against fraud and misallocation, demonstrating the commitment of financial institutions to safeguard their clients’ assets. The next time you engage in a banking transaction, remember the invaluable role of CoP in ensuring the security of your financial interests.
For more details, you can visit https://technoxander.com.
An accounting information system (AIS) refers to tools and systems designed for the collection and display of accounting information so accountants and executives can make informed decisions.
South Dakota State University degree offer diploma Transcriptynfqplhm
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Discovering Delhi - India's Cultural Capital.pptxcosmo-soil
Delhi, the heartbeat of India, offers a rich blend of history, culture, and modernity. From iconic landmarks like the Red Fort to bustling commercial hubs and vibrant culinary scenes, Delhi's real estate landscape is dynamic and diverse. Discover the essence of India's capital, where tradition meets innovation.
Dr. Alyce Su Cover Story - China's Investment Leadermsthrill
In World Expo 2010 Shanghai – the most visited Expo in the World History
https://www.britannica.com/event/Expo-Shanghai-2010
China’s official organizer of the Expo, CCPIT (China Council for the Promotion of International Trade https://en.ccpit.org/) has chosen Dr. Alyce Su as the Cover Person with Cover Story, in the Expo’s official magazine distributed throughout the Expo, showcasing China’s New Generation of Leaders to the World.
Fabular Frames and the Four Ratio ProblemMajid Iqbal
Digital, interactive art showing the struggle of a society in providing for its present population while also saving planetary resources for future generations. Spread across several frames, the art is actually the rendering of real and speculative data. The stereographic projections change shape in response to prompts and provocations. Visitors interact with the model through speculative statements about how to increase savings across communities, regions, ecosystems and environments. Their fabulations combined with random noise, i.e. factors beyond control, have a dramatic effect on the societal transition. Things get better. Things get worse. The aim is to give visitors a new grasp and feel of the ongoing struggles in democracies around the world.
Stunning art in the small multiples format brings out the spatiotemporal nature of societal transitions, against backdrop issues such as energy, housing, waste, farmland and forest. In each frame we see hopeful and frightful interplays between spending and saving. Problems emerge when one of the two parts of the existential anaglyph rapidly shrinks like Arctic ice, as factors cross thresholds. Ecological wealth and intergenerational equity areFour at stake. Not enough spending could mean economic stress, social unrest and political conflict. Not enough saving and there will be climate breakdown and ‘bankruptcy’. So where does speculative design start and the gambling and betting end? Behind each fabular frame is a four ratio problem. Each ratio reflects the level of sacrifice and self-restraint a society is willing to accept, against promises of prosperity and freedom. Some values seem to stabilise a frame while others cause collapse. Get the ratios right and we can have it all. Get them wrong and things get more desperate.
How to Invest in Cryptocurrency for Beginners: A Complete GuideDaniel
Cryptocurrency is digital money that operates independently of a central authority, utilizing cryptography for security. Unlike traditional currencies issued by governments (fiat currencies), cryptocurrencies are decentralized and typically operate on a technology called blockchain. Each cryptocurrency transaction is recorded on a public ledger, ensuring transparency and security.
Cryptocurrencies can be used for various purposes, including online purchases, investment opportunities, and as a means of transferring value globally without the need for intermediaries like banks.
A toxic combination of 15 years of low growth, and four decades of high inequality, has left Britain poorer and falling behind its peers. Productivity growth is weak and public investment is low, while wages today are no higher than they were before the financial crisis. Britain needs a new economic strategy to lift itself out of stagnation.
Scotland is in many ways a microcosm of this challenge. It has become a hub for creative industries, is home to several world-class universities and a thriving community of businesses – strengths that need to be harness and leveraged. But it also has high levels of deprivation, with homelessness reaching a record high and nearly half a million people living in very deep poverty last year. Scotland won’t be truly thriving unless it finds ways to ensure that all its inhabitants benefit from growth and investment. This is the central challenge facing policy makers both in Holyrood and Westminster.
What should a new national economic strategy for Scotland include? What would the pursuit of stronger economic growth mean for local, national and UK-wide policy makers? How will economic change affect the jobs we do, the places we live and the businesses we work for? And what are the prospects for cities like Glasgow, and nations like Scotland, in rising to these challenges?
Ending stagnation: How to boost prosperity across Scotland
Embracing Accountable Care - 10 Key Steps
1. Embracing Accountable Care: 10 Key Steps
– Sivakumar Nandiwada and Vijay Sylvestine
Abstract
For quite some time now, the U.S. healthcare market has been grappling with
issues of spiraling costs and disparities in the quality of care delivered. These
issues can be attributed to the predominant fee-for-service reimbursement
model that rewards quantity over quality, as well as a disjointed healthcare
delivery system that has led to gaps and redundancies in care delivery. The
recent Affordable Care Act (ACA) introduced the concept of an Accountable
Care Organization (ACO) – a reformed payment and delivery system that
addresses some of the issues above.
Though the proposal under ACA aims at establishing Medicare ACOs, the
concept has seen an uptake especially among large commercial insurers – with
several pilot projects up and running. However, 6 out of 10 payers polled in
a recent Infosys Public Services survey were still in the initial planning stages
of setting up ACOs. In a competitive landscape, it has become no less than
an imperative for payers to seriously evaluate the need to embrace the ACO
concept.
This Point of View examines key steps payers must take to establish and
successfully manage ACOs — enhancing their ability to remain competitive
through 2012 and beyond.
2. Background
An ACO is a provider-led organization that will be responsible for managing the full continuum of care for a
defined population, while also being accountable for the overall cost and quality of care that is delivered. The
performance of ACOs will be measured across a set of parameters like efficiency, process and patient satisfaction.
ACOs will be incentivized based on the treatment cost savings they are able to achieve while delivering quality
care.
ACO as a concept is not new; an ACO resembles the
historical model of a Physician Hospital Organization ACO Principles
(PHO), which also created shared incentives and risks
for providers. But these past models failed due to the
unavailability of information required for managing the
risk associated with patients, as well as an effective care
management system. With coordinated care delivery
and accountability, ACOs can help payers reduce
Meaningful
medical costs through efficient resource utilization, Coordinated Performance Aligned
Care Incentives
Measures
reduced unit costs and improved outcomes.
Furthermore, this model will also allow payers to transfer some of the financial risks to the ACO when the
treatment costs exceed the defined spending targets.
A survey conducted by Infosys Public Services at a recent America’s Health Insurance Plan (AHIP) conference
establishes that a majority of payers (more than 60%) are still in the initial planning stages of setting up ACOs.
To remain competitive, it is imperative for payers to evaluate the need to embrace the ACO model and begin
their ACO planning as soon as possible.
Readiness Towards Implementationof ACO
Readiness Towards Implementation of ACO
8% Not Started
53% Planning
35% Implementing Now
4% Implementing in 2012
Source: Infosys Public Services survey at America’s Health Insurance Plan (AHIP) Fall Forum 2011
Adopting an ACO model is a transformational change, and will require substantial planning and preparation
from payers. A rapid transition to ACO could possibly overwhelm the organization and place considerable
strain on the existing business process, people and systems. Given the uncertainties crowding the contracting
model and reimbursement models (to be employed under the ACO concept), it will be beneficial for payers to
commence pilot projects that can help assess what works and what doesn’t – and plan their ACO investments
appropriately. This in mind, payers need to put together a robust plan towards acquiring key capabilities in
addition to following a phased approach to implementation.
2 | Infosys Public Services | Point of View
3. 10 Key Steps Payers Must Take
The key capabilities payers would need in order to commence pilot projects can be broadly classified into
3 phases:
• ACO Program Planning
• ACO Program Administration
• ACO Program Evaluation and Optimization
ACO Program Planning
Establish the Business Objectives
Identify a Program Sponsor & Funding Source
ACO Program Administration
Set up ACO Structure
Attribute Members
Negotiate Provider Contracts & Define
Performance Measures
Define Budget & Spending Targets
Develop the IT Infrastructure
Harness Business Intelligence
and Data Analytics
ACO Program Evaluation
&
Optimization
Collect & Evaluate Performance Data
Share Capabilities & Best Practices
Infosys Public Services | Point of View | 3
4. ACO Program Planning
Establish the Business Objectives ACO Program Planning
1
Payers must decide on the specific objectives that they wish to achieve by partnering with ACOs – like
optimization of utilization rates; reduction of re-admission rates; improving primary care physician (PCP)
engagement; improving patient access; or enhancing the effectiveness of care for certain populations.
To begin their ACO journey, payers must define a plan to achieve these objectives and quantify the goals that
need to be achieved by the ACOs identified.
It is important to note that such objectives can only be established after careful analysis of member and provider
data with regard to clinical and health outcomes.
Identify a Program Sponsor & Funding Source ACO Program Planning
2
Being strategic initiatives, ACOs will need buy-in and support from the executive management team. Executive
sponsorship (from either the CEO or the CIO) will help market the concept to the various stakeholders – who
will be impacted by the changes – and get their buy-in.
Executive sponsorship will also be beneficial in securing necessary funds. Given the magnitude of changes that
will come along, the executive sponsor will need to be supported by a cross-functional team – comprising senior
leadership from the Project Management Office, Provider Network Management, Medical Management, Product
Development, Legal and Finance departments, among others.
A key consideration here is that it will be absolutely necessary for the sponsor to ensure that the entire executive
team is in agreement with the objectives of the ACO program and the shift to an ACO model.
ACOs will need significant capital for developing necessary IT infrastructure and staff recruitment, apart from
other administrative tasks. There are multiple funding models from an ACO standpoint. Payers need to decide
if they are willing to fund the cost of the initial infrastructure that ACOs need to set up, especially when it
comes to smaller ACOs. This could help alleviate the initial financial barriers that ACOs face and promote ACO
participation.
The Center for Medicare and Medicaid Services (CMS) has come out with a similar Advance Payment ACO
model for its Medicare ACO program, in which ACOs will receive advances against future shared savings.
Keeping in mind that this funding is an advance against future savings (that may or may not materialize), payers
need to perform careful financial planning to set aside appropriate funds that can help integrate people, process
and technology changes with an ACO.
4 | Infosys Public Services | Point of View
5. ACO Program Administration
This can be done in multiple phases for different ACOs, so the learning from one cycle can be applied to other
cycles.
Set up ACO Structure ACO Program Administration
3
The initial step for a payer participating with an ACO is to ascertain the geographic spread of the ACO and the
kind of association that participating providers have with the ACO entity. Payers must also determine the mix of
provider types within the ACO and define goals aligned to the provider mix.
An ACO comprising only primary care physicians (PCPs) can effectively coordinate care and promote preventive
care, but this type of an ACO will not have the organizational alignment required to drive efficiencies and cost
savings across the entire continuum of care delivery, especially in areas like in-patient care and ambulatory
care. Ascertaining the provider mix will also help identify providers under the ACO who do not have existing
contracts with the payer.
The nature of the relationship model that exists between providers and the ACO entity (integrated model /
collective model / combination model) will define the subsequent steps in ACO program administration; hence,
the model needs to be identified upfront. Payers must attune their systems and processes to support different
ACO structures.
Attribute Members ACO Program Administration
4
Once the ACO structure is finalized, payers must employ a patient attribution algorithm to attribute members
to the ACO, and the ACO will be accountable for the quality and cost of treatment of these attributed members.
Selection of such members can be based on the following parameters:
• Coverage type; e.g., medical vs. dental coverage
• Group type; e.g., large vs. small group
• Product type; e.g., preferred provider organization (PPO) vs. health maintenance organization (HMO)
• Line of business; e.g., Medicare vs. Medicaid vs. Senior
• Funding type; e.g., fully insured vs. administrative services only (ASO)
Payers can choose one of the many attribution methodologies available to complete the member attribution like
Dartmouth model vs. Employer-Group-based model vs. PCP-based model. Constant churn is a possibility; to
that end, payers must establish mechanisms to manage additions and terminations to the attributed population.
The focus of this attribution process must be to capitalize on the existing member-provider relationships to
achieve a personalized coordinated care for patients.
Infosys Public Services | Point of View | 5
6. Negotiate Provider Contracts & Define
Performance Measures ACO Program Administration
5
ACOs must be appropriately rewarded for delivering high-quality, appropriately-priced care to patients.
Conversely, ACOs must be penalized for failing to achieve cost and outcome goals that are within their control.
The contract between the payer and the ACO must clearly define the following performance measures:
• Population that the ACO is going to be accountable for
• Quality, cost and efficiency (if needed) parameters that will be used to evaluate the performance of the ACO
and the targets for each of these parameters
• Potential incentives that the ACO will receive for achieving the targets defined or the penalties that the
ACO will be liable for if it fails to achieve the targets defined
Paramount to the success of the ACO model is the definition of performance measures and benchmarks that
will help evaluate ACO performance effectively. The measures selected must be in line with the ACO program
objectives that the payer is trying to achieve. Improved outcomes will lead to a focus on quality-related measures,
and a focus on optimal utilization will lead to the setting up of efficiency-related measures. Payers must seek
inputs from ACOs to define measures that will be relevant to the program and do not place undue administrative
burdens on the ACOs. The measures selected must be quantifiable, evidence-based, and clinically valid, while
being relevant to the program constituents.
Define Budget & Spending Targets ACO Program Administration
6
Actuarial projections of future expenses for the ACO-assigned population must be completed by the payer based
on historical claim data or on a control group approach, and a mutually agreed upon spending target must be
defined for the ACO. Prediction based on historical claim data has advantages over the other approach because
it allows the payers to define prospective targets for the ACO at the beginning of the performance year itself.
This allows the ACO to compare its actual performance and make necessary course corrections. The spending
targets must be risk-adjusted for variations in the risk profile of the patients assigned with a view to incentivize:
• Providers who treat sicker patients to participate in ACOs
• ACOs to accept and treat sicker patients
The spending targets must also be adjusted for different geographic practice costs, including office rents and
hospital operating costs.
Develop the IT Infrastructure ACO Program Administration
7
The adoption of the ACO model necessitates system changes at the payer-end to support newer capabilities like
member attribution, and risk and reward modeling. Additionally, significant changes to existing payer systems
will be needed primarily in provider contracting, claims adjudication and payment processing systems. Payers
will also need to invest in performance evaluation and reporting systems. With no consistent model in sight for
ACOs, payers must develop systems that are flexible enough to adapt to ACO variations without much effort.
6 | Infosys Public Services | Point of View
7. Harness Business Intelligence
ACO Program Administration
and Data Analytics
8
Care management has been one of the top investment destinations for payers. Even so, due to their increasingly
older and sicker membership, they have been challenged in determining the ROI and savings they realize from
such programs. With the MLR mandate qualifying healthcare program costs as ‘non-administrative’ expenses and
also limiting the profits that the payers can make, payers must carefully plan their investments and also track
program savings. With the ACO model, it is imperative for the payers to forecast the program budget, define
objective targets and measure ACO performance against the targets periodically to track program value.
Payers must develop analytical abilities around effective attribution of members, risk and reward modeling and
performance assessment to support the new ACO model. Payers must shift their focus from traditional areas
involving analytics to newer ones and also invest on predictive and forecasting capabilities.
ACO Program Evaluation and Optimization
Collect & Evaluate Performance Data ACO Program Evaluation & Optimization
9
The ability to collect, analyze and evaluate the performance of participating providers in an objective and
transparent manner, which providers find easy to understand, is absolutely necessary for the success of the ACO
model. Performance evaluation in an ACO model must extend beyond traditional clinical process measures
and must include measures like outcomes, patient experience and treatment cost. In addition, the results of the
performance evaluation exercise must be made available to the public or at least to the patients participating
in the ACO program. If ACOs are able to demonstrate cost savings while delivering quality care, this public
reporting of quality data will lead to more patients choosing high-performing ACOs over others, resulting in
increased utilization rate for ACOs. It may also bring in additional revenue in the form of non-ACO population
opting to take services from the ACO providers and will act to improve ACO participation.
Share Capabilities & Best Practices ACO Program Evaluation & Optimization
10
To ensure success, payers and ACOs will need to develop a deeper and broader relationship than what has been
traditionally practised. With the transition to ACO, providers will take up the responsibility for some of the
key functions performed traditionally by the payer – including case management, network management and
medical management. Since the payers already have significant experience in these areas, they must share their
experience and enable the ACOs to dispatch these newer responsibilities in a better manner. Payers can also
build on their existing disease management and wellness management capabilities and offer them as services to
the ACOs, thereby creating a new revenue stream. A key area for collaboration can be around the monitoring
and reporting of out-of-network services that a patient has incurred, helping the ACO gain a complete view of
the patient’s health.
Infosys Public Services | Point of View | 7